Francisco J. Valera

Long-term clinical experience with the omnicarbon prosthetic valve

BACKGROUND From February 1985 to December 1994, 781 Omnicarbon valve prostheses were implanted in 647 patients. These were 357 male and 290 female patients with a mean age of 53.5+/-10.5 years (range, 4 to 78 years). Before operation, 81% of the patients were in New York Heart Association class III or IV, 16% were in class II, and only 3% were in class I. METHODS There were 227 aortic valve replacements (AVR) (35%), 286 mitral valve replacements (MVR) (44%), and 134 double-valve replacements (DVR) (21%) (AVR + MVR). Follow-up was 96.3% complete and consisted of 2,746 patient-years (mean follow-up, 4.6 years, and maximum follow-up, 10.7 years). RESULTS Hospital mortality rates were 7.0% for AVR, 8.0% for MVR, and 8.2% for DVR. The annualized rate of anticoagulant-related hemorrhage was 0.8% per patient-year, and thromboembolism occurred at a rate of 0.7% per patient-year. No structural failure was observed during 10-year follow-up. Twenty-one instances of nonstructural dysfunction (two, pannus growth, and 19, dehiscence) of the Omnicarbon valve occurred in 20 patients, an incidence of 0.8% per patient-year. Hemolytic anemia was observed only in the presence of valvular dehiscence (6 of 19). Eight patients (0.3% per patient-year) had development of prosthetic valve endocarditis (4, AVR; 2, MVR; and 2 DVR). At the end of 10 years of follow-up, 91% of the survivors were in New York Heart Association class I or II. The overall survival rate at 10 years was 82.5%+/-2.6% (85.0%+/-3.9%, AVR; 81.0%+/-4.1%, MVR; and 82.5%+/-2.6%, DVR). Considering only valve-related deaths, the survival rate at 10 years was 91.9%+/-2.4% (90.0%+/-2.7%, AVR; 93.1%+/-3.8%, MVR; and 90.0%+/-1.8%, DVR). CONCLUSIONS Clinical results over a 10-year follow-up are excellent with the Omnicarbon prosthesis.

Abordaje biauricular transeptal superior en el tratamiento quirúrgico del mixoma auricular izquierdo de gran tamaño

Evitar la fragmentacion del tejido mixoide durante el acto quirurgico y resecar todo el espesor del septo interauricular con implantacion tumoral son las dos claves para evitar las graves complicaciones de embolia peroperatoria y recidiva postoperatoria en el tratamiento quirurgico del mixoma auricular izquierdo. La via transeptal superior nos ha permitido, en tres pacientes, la extirpacion en bloque de mixomas de gran tamano con facilidad y sin complicaciones.

Cirugía abierta de los aneurismas de cayado aórtico

La tecnica quirurgica optima para el tratamiento de la enfermedad aneurismatica extensa de la aorta toracica no esta claramente establecida. Las opciones incluyen un procedimiento en estadios, por esternotomia media, habitualmente incorporando una trompa de elefante, en el primero, seguido por toracotomia izquierda para completar el procedimiento. Una segunda opcion es un procedimiento en un estadio realizado mediante ester-notomia media exclusivamente, o bien, esternotomia media extendida mediante incision a traves de un espacio intercostal, o bien, toracotomia anterior bilateral (incision clamshell ).